{"id":11908,"date":"2020-05-05T23:16:07","date_gmt":"2020-05-05T21:16:07","guid":{"rendered":"https:\/\/www.synevo.ro\/shop\/indice-homa\/"},"modified":"2026-02-19T01:11:00","modified_gmt":"2026-02-18T23:11:00","slug":"indice-homa","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/indice-homa\/","title":{"rendered":"\u0418\u043d\u0434\u0435\u043a\u0441 HOMA-IR"},"content":{"rendered":"

Indice HOMA (rezisten\u021ba la insulin\u0103) con\u021bine Glucoz\u0103 seric\u0103 \u0219i Insulin\u0103<\/b><\/p>\r\n

Informa\u021bii generale<\/i><\/b><\/p>\r\n

Rezisten\u021ba la insulin\u0103<\/i> reprezint\u0103 o condi\u021bie patologic\u0103 caracterizat\u0103 printr-un r\u0103spuns suboptimal al \u021besuturilor periferice la ac\u021biunea insulinei1<\/sup>.<\/p>\r\n

Rezisten\u021ba la insulin\u0103 se manifest\u0103 \u00een special la nivelul \u021besuturilor ce depind de ac\u021biunea insulinei pentru transportul intracelular al glucozei: ficat, mu\u0219chi \u0219i \u021besut adipos. Efectele rezisten\u021bei la insulin\u0103 sunt, \u00eens\u0103, multiple, deoarece insulina exercit\u0103 ac\u021biuni fiziologice asupra metabolismului glucidic, lipidic \u0219i proteic, precum \u0219i asupra func\u021biei endoteliale2<\/sup>.<\/p>\r\n

Rezisten\u021ba la insulin\u0103 este tulburarea metabolic\u0103 primar\u0103 asociat\u0103 cu obezitatea \u0219i pare s\u0103 fie mediatorul principal al sindromului metabolic3<\/sup>.<\/p>\r\n

Sindromul metabolic<\/i> este definit prin prezen\u021ba a 3 din urm\u0103toarele criterii (conform consensului din 2009 al unor foruri interna\u021bionale importante: Federa\u021bia Interna\u021bional\u0103 de Diabet, Federa\u021bia Mondial\u0103 de Cardiologie, Societatea Interna\u021bional\u0103 de Ateroscleroz\u0103, Societatea American\u0103 de Cardiologie)4<\/sup>:<\/p>\r\n

1. prezen\u021ba obezit\u0103\u021bii abdominale (circumferin\u021ba abdominal\u0103 peste 80 cm la femei \u0219i peste 94 cm la b\u0103rba\u021bii europeni);<\/div>\r\n
2. niveluri crescute ale trigliceridelor \u2265 150 mg\/dL (1.7 mmol\/L) sau efectuarea de tratament pentru trigiceride crescute;<\/div>\r\n
3. niveluri sc\u0103zute ale HDL-colesterolului <40 mg\/dL (1 mmol\/L) la b\u0103rba\u021bi \u0219i <50 mg\/dL (1.3 mmol\/L) la femei sau efectuarea de tratament pentru HDL sc\u0103zut;<\/div>\r\n
4. valori ale tensiunii arteriale sistolice \u2265 130 mmHg \u0219i\/sau ale celei diastolice \u2265 85 mmHg sau efectuarea de tratament pentru hipertensiune arterial\u0103;<\/div>\r\n
5. valori crescute ale glicemiei bazale \u2265 100 mg\/dL sau efectuarea de tratament pentru diabet zaharat diagnosticat anterior.<\/div>\r\n

A\u0219a cum reiese din defini\u021bie, sindromul metabolic nu este o afec\u021biune \u00een sine ci reune\u0219te o serie de tulbur\u0103ri metabolice ce identific\u0103 persoanele cu risc crescut de a dezvolta boli cardiovasculare \u0219i diabet zaharat de tip 2. Astfel, prezen\u021ba sindromului metabolic confer\u0103 un risc de trei ori mai mare de apari\u021bie a bolii coronariene \u0219i a accidentului vascular cerebral, dubl\u00e2nd mortalitatea din aceste cauze. Riscul de moarte subit\u0103 este de cinci ori mai mare la pacien\u021bii cu diabet zaharat \u0219i de 2-3 ori mai mare la pacien\u021bii cu sindrom metabolic. Dac\u0103 diabetul zaharat nu este deja prezent, sindromul metabolic cre\u0219te de cinci ori riscul de apari\u021bie a diabetului zaharat de tip 22;5<\/sup>.<\/p>\r\n

La apari\u021bia sindromului metabolic contribuie mai mul\u021bi factori ce includ: activitatea fizic\u0103 sc\u0103zut\u0103, predispozi\u021bia genetic\u0103, inflama\u021bia cronic\u0103, acizii gra\u0219i liberi \u0219i disfunc\u021bia mitocondrial\u0103. Se pare c\u0103 rezisten\u021ba la insulin\u0103 reprezint\u0103 principala verig\u0103 ce leag\u0103 aceste elemente, obezitatea \u0219i sindromul metabolic.<\/p>\r\n

Insulina se leag\u0103 \u0219i ac\u021bioneaz\u0103 \u00een principal prin receptorul insulinei; ac\u021bioneaz\u0103 deasemenea \u0219i via receptorul pentru IGF-1 (insulin-growth factor-1). Ac\u021biunile celulare ale insulinei implic\u0103 un spectru larg de efecte exercitate asupra c\u0103ilor de semnalizare postreceptor din celulele \u021bint\u01036<\/sup>.<\/p>\r\n

Astfel, \u00een condi\u021bii normale, insulina stimuleaz\u0103 captarea glucozei \u00een \u021besutul muscular, inhib\u0103 gluconeogeneza hepatic\u0103, scade lipoliza de la nivelul \u021besutului adipos \u0219i reduce produc\u021bia hepatic\u0103 de lipoproteine cu densitate foarte sc\u0103zut\u0103 (VLDL). La nivel cerebral, activarea lan\u021bului de semnalizare a insulinei are ca efect reducerea apetitului \u0219i previne produc\u021bia hepatic\u0103 de glucoz\u0103 prin semnalele neuronale din hipotalamus. Rezisten\u021ba la insulin\u0103 conduce \u00eens\u0103 la eliberarea de acizi gra\u0219i liberi din \u021besutul adipos, cre\u0219terea produc\u021biei hepatice de VLDL \u0219i sc\u0103derea lipoproteinelor cu densitate crescut\u0103 (HDL). Produc\u021bia crescut\u0103 de acizi gra\u0219i liberi, citokine proinflamatorii \u0219i adipokine precum \u0219i disfunc\u021bia mitocondrial\u0103 contribuie la perturbarea semnaliz\u0103rii mediat\u0103 de insulin\u0103, captarea sc\u0103zut\u0103 a glucozei la nivelul musculaturii scheletice, cre\u0219terea gluconeogenezei hepatice \u0219i disfunc\u021bia celulelor \u03b2 pancreatice, ceea ce va determina apari\u021bia hiperglicemiei6<\/sup>. \u00cen plus, rezisten\u021ba la insulin\u0103 conduce la dezvoltarea hipertensiunii arteriale prin disfunc\u021bia endotelial\u0103 asociat\u0103, ce se caracterizeaz\u0103 printr-o produc\u021bie sc\u0103zut\u0103 de oxid nitric \u0219i o eliberare exagerat\u0103 de endotelin7;8<\/sup>.<\/p>\r\n

Rezisten\u021ba la insulin\u0103 are la baz\u0103 at\u00e2t cauze ereditare c\u00e2t \u0219i dob\u00e2ndite. \u00cen func\u021bie de localizarea efectului lor primar \u00een raport cu receptorul insulinei aceste cauze pot fi clasificate \u00een:<\/p>\r\n

–\u00a0cauze prereceptor: molecul\u0103 anormal\u0103 de insulin\u0103 datorit\u0103 unor muta\u021bii genetice, prezen\u021ba de anticorpi anti-insulin\u0103;<\/div>\r\n
–\u00a0cauze ce afecteaz\u0103 receptorul insulinei: sc\u0103derea num\u0103rului de receptori, reducerea capacit\u0103\u021bii de legare a insulinei, muta\u021bii ale receptorului, prezen\u021ba de anticorpi blocan\u021bi ai receptorului;<\/div>\r\n
– cauze postreceptor: defecte de transmitere a semnalului, muta\u021bii ale transportorului 4 al glucozei GLUT4 (principalul transportor responsiv la insulin\u0103).<\/div>\r\n

Alte condi\u021bii care pot determina rezisten\u021b\u0103 la insulin\u0103 sunt reprezentate de: activitatea fizic\u0103 sc\u0103zut\u0103, procesul de \u00eemb\u0103tr\u00e2nire, acizii gra\u0219i liberi \u00een cantit\u0103\u021bi crescute, inflama\u021bia cronic\u0103, glucocorticoizii, terapia anti-HIV, disfunc\u021bia mitocondrial\u01036<\/sup>.<\/p>\r\n

Interesul manifestat de cercet\u0103tori fa\u021b\u0103 de rezisten\u021ba la insulin\u0103 \u0219i sindromul metabolic se datoreaz\u0103 prevalen\u021bei lor crescute \u00een popula\u021bie precum \u0219i riscului asociat de boal\u0103 coronarian\u0103 \u0219i diabet zaharat tip 21<\/sup>.<\/p>\r\n

Exist\u0103 numeroase dovezi care indic\u0103 faptul c\u0103 atunci c\u00e2nd se dezvolt\u0103 intoleran\u021ba la glucoz\u0103 sau nivelurile glicemiei bazale devin anormale s-a produs deja un grad de distruc\u021bie a celulelor \u03b2. Din acest motiv, tentativele de a preveni diabetul zaharat tip 2 ar avea mai mult succes dac\u0103 s-ar interveni precoce, c\u00e2nd nivelurile glicemiei sunt \u00eenc\u0103 normale. Astfel, sunt necesare investiga\u021bii simple pentru identificarea rezisten\u021bei la insulin\u0103 \u00een practica medical\u0103 curent\u01039<\/sup>.<\/p>\r\n

Metoda-etalon de m\u0103surare a rezisten\u021bei la insulin\u0103 este metoda \u201ceuglycemic clamp\u201d. \u00cen cursul probei se determin\u0103 cantitatea de glucoz\u0103 administrat\u0103 pentru a men\u021bine constant nivelul bazal al glicemiei, \u00een condi\u021biile realiz\u0103rii unui nivel crescut constant al insulinemiei. Cantitatea de glucoz\u0103 ce trebuie administrat\u0103 variaz\u0103 de la un individ la altul, \u00een func\u021bie de sensibilitatea la insulin\u01032<\/sup>. Metoda este \u00eens\u0103 laborioas\u0103 \u0219i consumatoare de timp, fiind accesibil\u0103 doar \u00een centre specializate.<\/p>\r\n

De-a lungul timpului au fost propuse c\u00e2teva metode alternative mai simple de evaluare a rezisten\u021bei la insulin\u0103, printre care se num\u0103r\u0103 \u0219i indicele HOMA10<\/sup>.<\/p>\r\n

Indicele HOMA (\u201cHomeostasis model assessment\u201d) a fost descris \u00een anul 1985 de c\u0103tre Matthews et al. pornind de la premiza c\u0103 nivelele glicemiei \u0219i insulinemiei \u00e0 jeun ale unui individ anume, av\u00e2nd sau nu o toleran\u021b\u0103 normal\u0103 la glucoz\u0103, sunt setate la un nivel caracteristic pentru acel individ. Astfel, \u00een condi\u021bii bazale rela\u021bia dintre glucoz\u0103 \u0219i insulin\u0103 reflect\u0103 echilibrul \u00eentre produc\u021bia hepatic\u0103 de glucoz\u0103 \u0219i secre\u021bia de insulin\u0103 a celulelor \u03b2 pan\u00adcreatice, care este men\u021binut printr-o bucl\u0103 feed-back \u00eentre ficat \u0219i celulele \u03b2. Deoarece rezisten\u021ba la insulin\u0103 ca \u0219i insu\u00adficien\u021ba r\u0103spunsului insulinosecretor au un r\u0103sunet echivalent la nivelul produc\u021biei hepatice de glucoz\u0103, se poate presupune c\u0103 hiperglicemia \u00e0 jeun este rezultatul unei combina\u021bii, \u00een propor\u021bii diferite, a deficien\u021bei celulelor \u03b2 \u0219i a rezisten\u021bei la insulin\u0103.<\/p>\r\n

HOMA-\u03b2<\/em><\/strong> m\u0103soar\u0103 capacitatea celulelor beta din pancreas de a produce insulin\u0103. O func\u021bie sc\u0103zut\u0103 a celulelor \u03b2, poate semnala o deteriorare a func\u021biei pancreasului \u0219i un risc crescut de a dezvolta diabet. Valorile HOMA-\u03b2 depind de secre\u021bia de insulin\u0103 \u0219i de de nivelul glicemiei, astfel se reflect\u0103 \u00een stadiile incipiente hipersecre\u021bia compensatorie a celulelor-\u03b2, iar ulterior declinul func\u021biei acestora (celulele-\u03b2 se epuizeaz\u0103).<\/p>\r\n

Disfunc\u021bia celulelor \u03b2-pancreatice (capacitatea de secre\u021bie de insulin\u0103) \u0219i rezisten\u021ba la insulin\u0103 sunt mecanismele patogenetice-cheie a tulbur\u0103rilor metabolice.<\/p>\r\n

Nu exist\u0103 un prag universal de referin\u021b\u0103, dar valori mai mici sugereaz\u0103 o func\u021bie redus\u0103, un semn al progresiei diabetului zaharat, iar valorile mai mari indic\u0103 o secre\u021bie compensatorie. Este un marker estimativ, reflect\u00e2nd secre\u021bia de insulin\u0103 a jeun, dar nu r\u0103spunsul dinamic la stimuli de glucoz\u0103.<\/p>\r\n

Interpretare HOMA-\u03b2\u00a0 <\/em><\/strong><\/p>\r\n

Nu exist\u0103 un prag universal de referin\u021b\u0103, dar valori mai mici sugereaz\u0103 o func\u021bie redus\u0103, un semn al progresiei diabetului zaharat, iar valorile mai mari indic\u0103 o secre\u021bie compensatorie. Este un marker estimativ, reflect\u00e2nd secre\u021bia de insulin\u0103 a jeun, dar nu r\u0103spunsul dinamic la stimuli de glucoz\u0103.<\/p>\r\n

<\/p>\r\n

Predic\u021biile formulate de modelul matematic HOMA se bazeaz\u0103 pe date experimentale ob\u021binute din studii pe oameni \u0219i animale. Modelul ini\u021bial (HOMA1) a fost calibrat pentru a da o func\u021bie a celulelor \u03b2 normal\u0103 de 100% \u0219i de rezisten\u021b\u0103 la insulin\u0103 normal\u0103 de 1. O rezisten\u021b\u0103 la insulin\u0103 crescut\u0103 este asociat\u0103 cu niveluri crescute ale insulinemiei bazale \u0219i o func\u021bie redus\u0103 a celulelor \u03b2 caracterizat\u0103 printr-o compensare redus\u0103 pentru a cre\u0219te nivelurile glicemiei. Consider\u00e2ndu-se aceast\u0103 interrela\u021bie glucoz\u0103-insulin\u0103, poate fi folosit\u0103 orice pereche de concentra\u021bii bazale ale glucozei \u0219i insulinei pentru a cuantifica rezisten\u021ba (HOMA1-IR) la insulin\u0103 \u0219i func\u021bia celulelor (\u03b2 HOMA1-%B) cu ajutorul urm\u0103toarelor formule:<\/p>\r\n

HOMA1-IR = (FPI (mU\/L) x FPG (mmol\/L))\/22.5<\/p>\r\n

FPI = insulinemia bazal\u0103 (\u00e0 jeun); FPG = glicemia bazal\u0103 (\u00e0 jeun)<\/p>\r\n

\u00cen cazul \u00een care glicemia bazal\u0103 este exprimat\u0103 \u00een mg\/dL, cifra numitorului se modific\u0103, de la 22.5 la 405.<\/p>\r\n

HOMA1-%B = (20 x FPI (mU\/L))\/(FPG (mmol\/L) \u2013 3.5)<\/p>\r\n

Cazurile cu nivele ale glicemiei \u00e0 jeun<\/i> \u2264 3,5 mmol\/l (63 mg\/dL) se exclud pentru a evita rezultatele negative11;12<\/sup>.<\/p>\r\n

\u00centre sensibilitatea la insulina estimat\u0103 prin HOMA \u0219i cea estimat\u0103 prin \u201eeuglycemic clamp\u201d a fost g\u0103sit\u0103 o corela\u021bie foarte str\u00e2ns\u0103 (r<\/i> = -0,820) \u00eentr-un studiu pe 115 subiec\u021bi europeni obezi \u0219i neo\u00adbezi, diabetici \u0219i nediabetici, normotensivi \u0219i hipertensivi, tineri \u0219i v\u00e2rstnici, b\u0103rba\u021bi \u0219i femei13<\/sup> \u0219i de asemenea \u00eentr-un studiu asupra 55 subiec\u021bi japonezi cu diabet tip 2 \u00eenainte (r<\/i> = – 0,613) \u0219i dup\u0103 (r<\/i> = – 0,734) trata\u00adment cu diet\u0103 \u0219i exerci\u021biu fizic14<\/sup>.<\/p>\r\n

Modelul ini\u021bial nu a luat \u00een considerare:<\/p>\r\n

–\u00a0diferen\u021bele \u00eentre\u00a0 sensibilitatea la insulin\u0103 a \u021besuturilor periferice \u0219i cea hepatic\u0103;<\/div>\r\n
–\u00a0cre\u0219terile secre\u021biei de insulin\u0103 \u0219i reducerea gluconeogenezei hepatice la valori ale glicemiei > 180 mg\/dL;<\/div>\r\n
– pierderile de glucoz\u0103 pe cale renal\u0103;<\/div>\r\n
– contribu\u021bia proinsulinei circulante.<\/div>\r\n

De asemenea, modelul ini\u021bial folose\u0219te ecua\u021bii ce au fost calibrate la testele de determinare a insulinei disponibile \u00een anii 1970.<\/p>\r\n

Din aceste motive, \u00een 1988 a fost elaborat un indice HOMA revizuit (HOMA2)\u00a0 care nu are la baz\u0103 o ecua\u021bie simpl\u0103 ci reprezint\u0103 o modelare computerizat\u0103 ce ia \u00een calcul varia\u021biile men\u021bionate15<\/sup>. O modalitate de calcul a indicelui HOMA2 se poate ob\u021bine prin accesarea website-ului http:\/\/www.dtu.oc.ac.uk\/homacalculator\/index.php<\/a><\/i>.<\/p>\r\n

Rezultatele unei metaanalize recente au ar\u0103tat c\u0103 riscul relativ de afec\u021biuni cardiovasculare la adul\u021bii nediabetici a fost mai mare \u00een cazul cre\u0219terii cu o devia\u021bie standard a indicelui \u00a0HOMA-IR dec\u00e2t \u00een situa\u021biile \u00een care s-a \u00eenregistrat o cre\u0219tere cu o devia\u021bie standard a nivelului bazal al glicemiei sau al insulinei. Din acest motiv, autorii sugereaz\u0103 c\u0103 HOMA-IR ar reprezenta un instrument cu valoare predictiv\u0103 asupra riscului cardiovascular16<\/sup>.<\/p>\r\n

De asemenea, rezisten\u021ba la insulin\u0103 estimat\u0103 cu ajutorul indicelui HOMA este asociat\u0103 cu un risc crescut de accident vascular cerebral la persoanele nediabetice17<\/sup>.<\/p>\r\n

Un alt studiu recent a indicat faptul c\u0103 HOMA-IR ar putea fi utilizat ca test de screening pentru intoleran\u021ba la glucoz\u0103 la femeile cu sindromul ovarelor polichistice PCOS, utiliz\u00e2nd valoarea cut-off de 218<\/sup>.<\/p>\r\n

Spre deosebire de adul\u021bi, \u00een popula\u021bia pediatric\u0103 lipsesc criteriile de definie a rezisten\u021bei la insulin\u0103. \u00centr-un studiu publicat recent, efectuat pe 342 copii, sunt evaluate c\u00e2teva metode de estimare a rezisten\u021bei la insulin\u0103. Autorii constat\u0103 c\u0103 indicele HOMA-IR reprezint\u0103 o metod\u0103 optim\u0103 de evaluare a rezisten\u021bei la insulin\u0103 la copiii supraponderali \u0219i obezi, \u00een timp ce utilizarea testului de toleran\u021b\u0103 la glucoz\u0103 per os (OGTT) \u00eent\u00e2rzie detectarea anomaliilor metabolismului glucidic la copii19<\/sup>.<\/p>\r\n

Recomand\u0103ri pentru determinarea indicelui HOMA <\/i><\/b>– evaluarea pacien\u021bilor cu indice de mas\u0103 corporal\u0103 BMI >28 kg\/m2<\/sup>; suspiciune de rezisten\u021b\u0103 la insulin\u0103 (sindrom metabolic, diabet zaharat tip 2); sindromul ovarelor polichistice20<\/sup>.<\/p>\r\n

Preg\u0103tire pacient <\/i><\/b>– <\/b><\/i>\u00e0 jeun (pe nem\u00e2ncate) – minim 8 ore21<\/sup>.<\/p>\r\n

Specimen recoltat <\/i><\/b>– <\/i>\u0432\u0435\u043d\u043e\u0437\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c20<\/sup>.<\/p>\r\n

Recipient de recoltare <\/i><\/b>– <\/i>vacutainer f\u0103r\u0103 anticoagulant, cu\/f\u0103r\u0103 gel separator21<\/sup>.<\/p>\r\n

Prelucrare necesar\u0103 dup\u0103 recoltare <\/i><\/b>– <\/b><\/i>se separ\u0103 serul prin centrifugare \u00een \u00eentr-un interval <2 ore\u00a0 de la recoltare21<\/sup>.<\/p>\r\n

Volum prob\u0103<\/i><\/b> – minim 1 mL ser21<\/sup>.<\/p>\r\n

Cauze de respingere<\/i><\/b> a probei <\/i><\/b>– specimen intens hemolizat21<\/sup>.<\/p>\r\n

Stabilitate prob\u0103 <\/i><\/b>– <\/b><\/i>serul separat este stabil 3 zile<\/i> la 2-8\u00b0C; 3 luni<\/i> la -20\u00b0C; nu decongela\u021bi\/recongela\u021bi21<\/sup>.<\/p>\r\n

Metod\u0103 <\/i><\/b><\/p>\r\n

Indicele HOMA se calculeaz\u0103 din nivelurile bazale ale glicemiei \u0219i insulinei dup\u0103 formula:
<\/b><\/p>\r\n

HOMA-IR = (insulin\u0103 (\u00b5U\/mL) x glicemie (mg\/dL))\/405.<\/p>\r\n

Pentru determinarea insulinei serice se utilizeaz\u0103 metoda imunochimic\u0103 cu detec\u021bie prin electrochemiluminiscen\u021b\u0103 (ECLIA).<\/span> Pentru determinarea glicemiei se folose\u0219te metoda spectrofotometric\u0103 (enzimatic\u0103 colorimetric\u0103)<\/span>21<\/sup>.<\/p>\r\n

Valori de referin\u021b\u0103 <\/i><\/b><\/p>\r\n

<2:\u00a0\u00a0\u00a0 normal;<\/div>\r\n
>2:\u00a0\u00a0\u00a0 posibil rezisten\u021b\u0103 la insulin\u0103;<\/div>\r\n
>2.5: probabilitate crescut\u0103 de rezisten\u021b\u0103 la insulin\u0103;<\/div>\r\n
>5:\u00a0\u00a0\u00a0 valoarea medie la persoane diabetice20<\/sup>.<\/div>\r\n

La copii \u0219i adolescen\u021bi definirea valorilor cut-off ale HOMA-IR pentru diagnosticul rezisten\u021bei la insulin\u0103 este mai dificil\u0103 dec\u00e2t la adul\u021bi datorit\u0103 absen\u021bei de studii longitudinale privind riscul cardiovascular. Pe de alt\u0103 parte, \u00een majoritatea studiilor, valorile cut-off au fost stabilite pe baza distribu\u021biei indicelui HOMA \u00eentr-o popula\u021bie de referin\u021b\u0103, dar datorit\u0103 factorilor de influen\u021b\u0103 cum ar fi pubertatea \u0219i diferen\u021bele etnice aceste valori au variat \u00eentre 1.8, 2.5, 3.2 sau >4 \u00een func\u021bie de popula\u021bia de referin\u021b\u0103 aleas\u0103.<\/p>\r\n

\u00centr-un studiu recent, efectuat pe un lot mare de copii din China s-au ob\u021binut urm\u0103toarele valori cut-off HOMA-IR:<\/p>\r\n

– pentru 95% din copiii s\u0103n\u0103to\u0219i: 3 (2.6 prepubertate \u0219i 3.2 \u00een perioada de pubertate);<\/div>\r\n
– pentru diagnosticul sindromului metabolic: 2.3 (1.7 prepubertate \u0219i 2.6 \u00een perioada de pubertate)3<\/sup>.<\/div>\r\n
\u00a0<\/div>\r\n
\r\n

<\/p>\r\n<\/div>\r\n

Limite \u0219i interferen\u021be<\/i><\/b><\/p>\r\n

Utilizarea HOMA-IR<\/strong><\/em> prezint\u0103 valoare limitat\u0103 la pacien\u021bii cu indice de mas\u0103 corporal\u0103 BMI sc\u0103zut, func\u021bie redus\u0103 a celulelor beta \u0219i niveluri crescute ale glicemiei bazale, cum este cazul pacien\u021bilor neobezi cu diabet zaharat de tip 2 cu defecte secretorii ale insulinei22<\/sup>.<\/p>\r\n

Utilizarea HOMA-\u03b2\u00a0 <\/em><\/strong>prezint\u0103 c\u0103 valorile ob\u021binute pot fi influen\u021bate de condi\u021bii acute, tratamente sau afec\u021biuni metabolice asociate.<\/p>\r\n

\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/strong><\/span><\/p>\r\n

1.\u00a0\u00a0Ascaso JF, Pardo S, Real JT, Lorente RI, Priego A, Carmena R. Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. \u00a0Diabetes Care. 2003 Dec;26(12):3320-5.<\/span><\/div>\r\n
2.\u00a0\u00a0Lichiardopol R. Rezisten\u021ba la insulin\u0103: un sindrom cu implica\u021bii multiple. British Medical Journal, ianuarie 2003. Ref Type: Internet Communication. www.bmj.ro<\/span><\/div>\r\n
3.\u00a0\u00a0Yin J<\/strong>, <\/b>Li M<\/strong>, <\/b>Xu<\/strong><\/b>\u041c, <\/b>Wang Y<\/strong>, <\/b>Cheng H<\/strong>, <\/b>Zhao X<\/strong>, <\/b>Mi J<\/strong>. <\/b>Insulin resistance determined by Homeostasis Model Assessment (HOMA) and associations with metabolic syndrome among Chinese children and teenagers. Diabetol Metab Syndr 2013 Nov 15;5(1):71.<\/span><\/div>\r\n
4. \u00a0Alberti KG<\/a>, Eckel RH<\/a>, Grundy SM<\/a>, Zimmet PZ<\/a>, Cleeman JI<\/a>, Donato KA<\/a>, Fruchart JC<\/a>, James WP<\/a>, Loria CM<\/a>, Smith SC Jr<\/a>; International Diabetes Federation Task Force on Epidemiology and Prevention<\/a>; Hational Heart, Lung, and Blood Institute<\/a>; \u0410\u043c\u0435\u0440\u0438\u043a\u0430\u043d\u0441\u043a\u0430\u044f \u0410\u0441\u0441\u043e\u0446\u0438\u0430\u0446\u0438\u044f \u0421\u0435\u0440\u0434\u0446\u0430<\/a>; World Heart Federation<\/a>; International Atherosclerosis Society<\/a>; International Association for the Study of Obesity<\/a>. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on<\/span><\/div>\r\n
Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation.<\/a> 2009 Oct 20;120(16):1640-5.<\/span><\/div>\r\n
5.\u00a0Kassi E, Pervanidou P, Kaltsas G, Chrousos G: Metabolic syndrome:definition and controversies. BMC Med 2011, 9:48.<\/span><\/div>\r\n
6.\u00a0Olatunbosun ST. Insulin Resistance. , www.emedicine.medscape.com<\/a>. Ref Type: Internet Communication.<\/span><\/div>\r\n
7.\u00a0Gallagher EJ<\/a>1<\/sup>, Leroith D<\/a>, Karnieli E<\/a>. Insulin resistance in obesity as the underlying cause for the metabolic syndrome. Mt Sinai J Med.<\/a> 2010 Sep-Oct;77(5):511-23.<\/span><\/div>\r\n
8.\u00a0Mather KJ<\/a>1<\/sup>, Steinberg HO<\/a>, Baron AD<\/a>. Insulin resistance in the vasculature. J Clin Invest.<\/a> 2013 Mar 1;123(3):1003-4.<\/span><\/div>\r\n
9.\u00a0McAuley KA<\/a>1<\/sup>, Williams SM<\/a>, Mann JI<\/a>, Walker RJ<\/a>, Lewis-Barned NJ<\/a>, Temple LA<\/a>, Duncan AW<\/a>. Diagnosing insulin resistance in the <\/b>general population. Diabetes Care.<\/a> 2001 Mar;24(3):460-4.<\/span><\/div>\r\n
10.\u00a0<\/b>Bonora E<\/a>1<\/sup>, Targher G<\/a>, Alberiche M<\/a>, Bonadonna RC<\/a>, Saggiani F<\/a>, Zenere MB<\/a>, Monauni T<\/a>, Muggeo M<\/a> Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care.<\/a> 2000 Jan;23(1):57-63.<\/span><\/div>\r\n
11.\u00a0Matthews DR, Hosker JP, Rudenski AS si col. Homeostasis model assessment: insulin resistance and \u03b2-cell function from fasting plasma glucose and insulin concentrations \u00een man. Diabetologia, 28: 412-419, 1985.<\/span><\/div>\r\n
12.\u00a0Julian A. HOMA: Often Mentioned, Rarely Defined. www.diabetesincontrol.com. 2009. Reference Type: Internet Communication.<\/span><\/div>\r\n
13.\u00a0Bonora E, Targher G, Alberiche M si col. Homeostasis Model Assessment Closely Mirrors the Glucose Clamp Technique \u00een the Assessment of Insulin Sensitivity. Diabetes Care, 23: 67-63, 2000.<\/span><\/div>\r\n
14.\u00a0Katsuki A, Sumido Y, Gabazza E si col. Homeostasis Model Assessment Is a Reliable Indicator of Insulin Resistance During Follow-up of Patients With Type 2 Diabetes. Diabetes Care, 24: 362- 365, 2001.<\/span><\/div>\r\n
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16.\u00a0Gast KB, Tjeerdema N, Stijnen T, Smit JW, Dekkers OM. Insulin resistance and risk of\u00a0 incident cardiovascular events in adults without diabetes: meta-analysis. PLoS One.<\/a> 2012;7(12):e52036.<\/span><\/div>\r\n
17.\u00a0Rundek T, Gardener H, Xu Q, Goldberg RB, Wright CB, Boden-Albala B, Disla N, Paik MC, Elkind MS, Sacco RL. Insulin\u00a0 resistance and risk of ischemic stroke among nondiabetic individuals from the northern Manhattan study. Arch Neurol.<\/a> 2010 Oct;67(10):1195-200.<\/span><\/div>\r\n
18.\u00a0Wongwananuruk T, Rattanachaiyanont M, Leerasiri P, Indhavivadhana S, Techatraisak K, Angsuwathana S, Tanmahasamut P, Dangrat C. The Usefulness of Homeostatic Measurement Assessment-Insulin Resistance (HOMA-IR) for Detection of Glucose Intolerance in Thai Women of Reproductive Age with Polycystic Ovary Syndrome. Int J Endocrinol.<\/a> 2012;2012:571035.<\/span><\/div>\r\n
19.\u00a0Pienar C, Stroescu R, Chirita-Emandi A, Dobrescu A, Puiu M. Evaluating insulin resistance in children: a critical appraisal of minimal methods. Revista Rom\u00e2n\u0103 de Pediatrie – volumul LXIII, nr. 1, an 2014.<\/span><\/div>\r\n
20.\u00a0Beineke M. Marker for the diagnosis of insulin resistance. Labor Bioscientia. www.bioscientia.de. Ref Type: Internet Communication.<\/span><\/div>\r\n
21.\u00a0Laborator Synevo. Referin\u021bele specifice tehnologiei de lucru utilizate. 2014. Ref Type: Catalog.<\/span><\/div>\r\n
22.\u00a0Kang ES, Yun YS, Park SW, Kim HJ, Ahn CW, Song YD, Cha BS, Lim SK, Kim KR, Lee HC. Limitation of the validity of the homeostasis model assessment as an index of insulin resistance in Korea. Metabolism.<\/a> 2005 Feb;54(2):206-11.<\/span><\/div>","protected":false},"excerpt":{"rendered":"

\u0418\u043d\u0441\u0443\u043b\u0438\u043d\u043e\u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u044c \u2013 \u044d\u0442\u043e \u0441\u043d\u0438\u0436\u0435\u043d\u0438\u0435 \u0447\u0443\u0432\u0441\u0442\u0432\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0441\u0442\u0438 \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u043e\u0437\u0430\u0432\u0438\u0441\u0438\u043c\u044b\u0445 \u043a\u043b\u0435\u0442\u043e\u043a \u043a \u0434\u0435\u0439\u0441\u0442\u0432\u0438\u044e \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0430 \u0441 \u043f\u043e\u0441\u043b\u0435\u0434\u0443\u044e\u0449\u0438\u043c \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0435\u043c \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0437\u043c\u0430 \u0433\u043b\u044e\u043a\u043e\u0437\u044b \u0438 \u043f\u043e\u0441\u0442\u0443\u043f\u043b\u0435\u043d\u0438\u044f \u0435\u0435 \u0432 \u043a\u043b\u0435\u0442\u043a\u0438. \u0420\u0430\u0437\u0432\u0438\u0442\u0438\u0435 \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443 \u043e\u0431\u0443\u0441\u043b\u043e\u0432\u043b\u0435\u043d\u043e \u0441\u043e\u0447\u0435\u0442\u0430\u043d\u0438\u0435\u043c \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0447\u0435\u0441\u043a\u0438\u0445, \u0433\u0435\u043c\u043e\u0434\u0438\u043d\u0430\u043c\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0439 \u043d\u0430 \u0444\u043e\u043d\u0435 \u0432\u043e\u0441\u043f\u0430\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u043f\u0440\u043e\u0446\u0435\u0441\u0441\u043e\u0432 \u0438 \u0433\u0435\u043d\u0435\u0442\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u043f\u0440\u0435\u0434\u0440\u0430\u0441\u043f\u043e\u043b\u043e\u0436\u0435\u043d\u043d\u043e\u0441\u0442\u0438 \u043a \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u043c. \u041f\u0440\u0438 \u044d\u0442\u043e\u043c \u043f\u043e\u0432\u044b\u0448\u0430\u0435\u0442\u0441\u044f \u0440\u0438\u0441\u043a \u0432\u043e\u0437\u043d\u0438\u043a\u043d\u043e\u0432\u0435\u043d\u0438\u044f \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0431\u0435\u0442\u0430, \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e-\u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439, \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u044f \u043e\u0431\u043c\u0435\u043d\u0430 \u0432\u0435\u0449\u0435\u0441\u0442\u0432, \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0430.<\/p>\n

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\u0414\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u043e\u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u043d \u0438\u043d\u0434\u0435\u043a\u0441 HOMA-IR (Homeostasis Model Assessment of Insulin Resistance). \u041e\u043d \u0440\u0430\u0441\u0441\u0447\u0438\u0442\u044b\u0432\u0430\u0435\u0442\u0441\u044f \u043f\u043e \u0444\u043e\u0440\u043c\u0443\u043b\u0435: HOMA-IR = \u0438\u043d\u0441\u0443\u043b\u0438\u043d \u043d\u0430\u0442\u043e\u0449\u0430\u043a (\u043c\u043a\u0435\u0434\/\u043c\u043b) x \u0433\u043b\u044e\u043a\u043e\u0437\u0430 \u043d\u0430\u0442\u043e\u0449\u0430\u043a (\u043c\u043c\u043e\u043b\u044c\/\u043b)\/22,5. \u041f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0439 HOMA-IR \u043e\u0442\u043c\u0435\u0447\u0430\u0435\u0442\u0441\u044f \u043f\u0440\u0438 \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0438 \u0443\u0440\u043e\u0432\u043d\u044f \u0433\u043b\u044e\u043a\u043e\u0437\u044b \u0438\u043b\u0438 \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0430 \u043d\u0430\u0442\u043e\u0449\u0430\u043a. \u042d\u0442\u043e \u0441\u043e\u043e\u0442\u0432\u0435\u0442\u0441\u0442\u0432\u0443\u0435\u0442 \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u044e \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a\u043b\u0435\u0442\u043e\u043a \u0438 \u0442\u043a\u0430\u043d\u0435\u0439 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443 \u0438 \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u043d\u043e\u043c\u0443 \u0440\u0438\u0441\u043a\u0443 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0431\u0435\u0442\u0430 2-\u0433\u043e \u0442\u0438\u043f\u0430 \u0438 \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e-\u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439. \u041f\u043e\u0440\u043e\u0433\u043e\u0432\u043e\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u0435 \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443, \u0440\u0430\u0441\u0441\u0447\u0438\u0442\u0430\u043d\u043d\u043e\u0439 \u0441 \u043f\u043e\u043c\u043e\u0449\u044c\u044e \u0438\u043d\u0434\u0435\u043a\u0441\u0430 HOMA-IR, \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u044f\u0435\u0442\u0441\u044f \u043a\u0430\u043a 70-75 \u043f\u0435\u0440\u0446\u0435\u043d\u0442\u0438\u043b\u0438 \u0435\u0433\u043e \u043a\u0443\u043c\u0443\u043b\u044f\u0442\u0438\u0432\u043d\u043e\u0433\u043e \u043f\u043e\u043f\u0443\u043b\u044f\u0446\u0438\u043e\u043d\u043d\u043e\u0433\u043e \u0440\u0430\u0441\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u044f.<\/p>\n

\u0418\u043d\u0434\u0435\u043a\u0441 \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u043e\u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u043d \u0432 \u043a\u0430\u0447\u0435\u0441\u0442\u0432\u0435 \u0434\u043e\u043f\u043e\u043b\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u044f \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0430. \u041c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u0441\u0438\u043d\u0434\u0440\u043e\u043c \u043f\u0440\u0435\u0434\u0441\u0442\u0430\u0432\u043b\u044f\u0435\u0442 \u0441\u043e\u0431\u043e\u0439 \u043a\u043e\u043c\u043f\u043b\u0435\u043a\u0441 \u0444\u0430\u043a\u0442\u043e\u0440\u043e\u0432 \u0440\u0438\u0441\u043a\u0430 \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e-\u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439, \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0431\u0435\u0442\u0430 2-\u0433\u043e \u0442\u0438\u043f\u0430, \u0430\u0442\u0435\u0440\u043e\u0441\u043a\u043b\u0435\u0440\u043e\u0437\u0430, \u0441\u0442\u0435\u0430\u0442\u043e\u0437\u0430 \u043f\u0435\u0447\u0435\u043d\u0438 \u0438 \u043d\u0435\u043a\u043e\u0442\u043e\u0440\u044b\u0445 \u0432\u0438\u0434\u043e\u0432 \u0440\u0430\u043a\u0430. \u0412 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0435 \u0440\u0430\u0437\u0432\u0438\u0432\u0430\u0435\u0442\u0441\u044f \u043a\u043e\u043c\u043f\u043b\u0435\u043a\u0441 \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0447\u0435\u0441\u043a\u0438\u0445, \u0433\u043e\u0440\u043c\u043e\u043d\u0430\u043b\u044c\u043d\u044b\u0445 \u0438 \u043a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0439 \u043d\u0430 \u0444\u043e\u043d\u0435 \u043e\u0436\u0438\u0440\u0435\u043d\u0438\u044f \u0432 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0435 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u043e\u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438.<\/p>\n

\u0418\u043d\u0434\u0435\u043a\u0441 HOMA-IR \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0442\u0438\u0432\u043d\u044b\u043c \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u0435\u043c \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0439 \u0442\u043e\u043b\u0435\u0440\u0430\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0433\u043b\u044e\u043a\u043e\u0437\u0435 \u0438 \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0431\u0435\u0442\u0430 \u0443 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043e\u0432 \u0441 \u0443\u0440\u043e\u0432\u043d\u0435\u043c \u0433\u043b\u044e\u043a\u043e\u0437\u044b \u043d\u0438\u0436\u0435 7 \u043c\u043c\u043e\u043b\u044c\/\u043b. \u0422\u0430\u043a\u0436\u0435 \u0440\u0430\u0441\u0447\u0435\u0442 \u0434\u0430\u043d\u043d\u043e\u0433\u043e \u043f\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u044f \u043c\u043e\u0436\u0435\u0442 \u0431\u044b\u0442\u044c \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u043d \u043f\u0440\u0438 \u043f\u043e\u0434\u043e\u0437\u0440\u0435\u043d\u0438\u0438 \u043d\u0430 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u0435 \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443 \u043f\u0440\u0438 \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0435 \u043f\u043e\u043b\u0438\u043a\u0438\u0441\u0442\u043e\u0437\u043d\u044b\u0445 \u044f\u0438\u0447\u043d\u0438\u043a\u043e\u0432 \u0443 \u0436\u0435\u043d\u0449\u0438\u043d, \u0433\u0435\u0441\u0442\u0430\u0446\u0438\u043e\u043d\u043d\u043e\u043c \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u043c \u0434\u0438\u0430\u0431\u0435\u0442\u0435, \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u043f\u043e\u0447\u0435\u0447\u043d\u043e\u0439 \u043d\u0435\u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u043e\u0441\u0442\u0438, \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430\u0445 \u0412 \u0438 \u0421, \u0441\u0442\u0435\u0430\u0442\u043e\u0437\u0435 \u043f\u0435\u0447\u0435\u043d\u0438 \u043d\u0435\u0430\u043b\u043a\u043e\u0433\u043e\u043b\u044c\u043d\u043e\u0439 \u044d\u0442\u0438\u043e\u043b\u043e\u0433\u0438\u0438, \u0440\u044f\u0434\u0435 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u043e\u043d\u043d\u044b\u0445, \u043e\u043d\u043a\u043e\u043b\u043e\u0433\u0438\u0447\u0435\u0441\u043a\u0438\u0445, \u0430\u0443\u0442\u043e\u0438\u043c\u043c\u0443\u043d\u043d\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439 \u0438 \u0442\u0435\u0440\u0430\u043f\u0438\u0438 \u043d\u0435\u043a\u043e\u0442\u043e\u0440\u044b\u043c\u0438 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u043c\u0438 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u0430\u043c\u0438 (\u0433\u043b\u044e\u043a\u043e\u043a\u043e\u0440\u0442\u0438\u043a\u043e\u0438\u0434\u044b, \u043e\u0440\u0430\u043b\u044c\u043d\u044b\u0435 \u043a\u043e\u043d\u0442\u0440\u0430\u0446\u0435\u043f\u0442\u0438\u0432\u044b \u0438 \u0434\u0440\u0443\u0433\u0438\u0435).<\/p>\n

\u0414\u043b\u044f \u0447\u0435\u0433\u043e \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/strong><\/p>\n

\u0414\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443.
\u0414\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u0440\u0438\u0441\u043a\u0430 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0431\u0435\u0442\u0430, \u0430\u0442\u0435\u0440\u043e\u0441\u043a\u043b\u0435\u0440\u043e\u0437\u0430, \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e-\u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439.
\u0414\u043b\u044f \u043a\u043e\u043c\u043f\u043b\u0435\u043a\u0441\u043d\u043e\u0439 \u043e\u0446\u0435\u043d\u043a\u0438 \u0432\u043e\u0437\u043c\u043e\u0436\u043d\u043e\u0433\u043e \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443 \u043f\u0440\u0438 \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0447\u0435\u0441\u043a\u043e\u043c \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0435, \u043f\u043e\u043b\u0438\u043a\u0438\u0441\u0442\u043e\u0437\u0435 \u044f\u0438\u0447\u043d\u0438\u043a\u043e\u0432, \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u043f\u043e\u0447\u0435\u0447\u043d\u043e\u0439 \u043d\u0435\u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u043e\u0441\u0442\u0438, \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430\u0445 \u0412 \u0438 \u0421, \u0441\u0442\u0435\u0430\u0442\u043e\u0437\u0435 \u043f\u0435\u0447\u0435\u043d\u0438.<\/p>\n

\u041a\u043e\u0433\u0434\u0430 \u043d\u0430\u0437\u043d\u0430\u0447\u0430\u0435\u0442\u0441\u044f \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435?<\/strong><\/p>\n

\u041f\u0440\u0438 \u043e\u0446\u0435\u043d\u043a\u0435 \u0440\u0438\u0441\u043a\u0430 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0438 \u043f\u0440\u0438 \u043a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u043f\u0440\u043e\u044f\u0432\u043b\u0435\u043d\u0438\u044f\u0445 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u0433\u0438\u043f\u0435\u0440\u0442\u0435\u043d\u0437\u0438\u0438, \u0438\u0448\u0435\u043c\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u0431\u043e\u043b\u0435\u0437\u043d\u0438 \u0441\u0435\u0440\u0434\u0446\u0430, \u0438\u0448\u0435\u043c\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e \u0438\u043d\u0441\u0443\u043b\u044c\u0442\u0430, \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u0433\u043e \u0434\u0438\u0430\u0431\u0435\u0442\u0430 2-\u0433\u043e \u0442\u0438\u043f\u0430, \u0430\u0442\u0435\u0440\u043e\u0441\u043a\u043b\u0435\u0440\u043e\u0437\u0430.<\/p>\n

\u0412 \u043a\u043e\u043c\u043f\u043b\u0435\u043a\u0441\u043d\u043e\u0439 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0435 \u043f\u0440\u0438 \u043f\u043e\u0434\u043e\u0437\u0440\u0435\u043d\u0438\u0438 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443 \u043f\u0440\u0438 \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0447\u0435\u0441\u043a\u043e\u043c \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0435, \u043f\u043e\u043b\u0438\u043a\u0438\u0441\u0442\u043e\u0437\u0435 \u044f\u0438\u0447\u043d\u0438\u043a\u043e\u0432, \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u043f\u043e\u0447\u0435\u0447\u043d\u043e\u0439 \u043d\u0435\u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u043e\u0441\u0442\u0438, \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0433\u0435\u043f\u0430\u0442\u0438\u0442\u0430\u0445 \u0412 \u0438 \u0421, \u043d\u0435\u0430\u043b\u043a\u043e\u0433\u043e\u043b\u044c\u043d\u043e\u043c \u0441\u0442\u0435\u0430\u0442\u043e\u0437\u0435 \u043f\u0435\u0447\u0435\u043d\u0438, \u0433\u0435\u0441\u0442\u0430\u0446\u0438\u043e\u043d\u043d\u043e\u043c \u0441\u0430\u0445\u0430\u0440\u043d\u043e\u043c \u0434\u0438\u0430\u0431\u0435\u0442\u0435, \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u043e\u043d\u043d\u044b\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u0445 \u0438 \u043f\u0440\u0438\u043c\u0435\u043d\u0435\u043d\u0438\u0438 \u043d\u0435\u043a\u043e\u0442\u043e\u0440\u044b\u0445 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0445 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u043e\u0432.<\/p>\n

\u0418\u043d\u0434\u0435\u043a\u0441 \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u043e\u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 (HOMA IR):<\/strong><\/em><\/p>\n

\u0414\u043b\u044f \u043b\u0438\u0446 \u043e\u0442 20 \u0434\u043e 60 \u043b\u0435\u0442: 0 \u2013 2,7.<\/p>\n

\u041f\u0440\u0438\u0447\u0438\u043d\u044b \u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u044f<\/strong><\/p>\n

    \n
  • \u041f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0435 \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443.<\/li>\n
  • \u0420\u0430\u0437\u0432\u0438\u0442\u0438\u0435 \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u043e\u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043f\u0440\u0438 \u0441\u043b\u0435\u0434\u0443\u044e\u0449\u0438\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f\u0445 \u0438 \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u044f\u0445:<\/li>\n
  • \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e-\u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u044b\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f;<\/li>\n
  • \u0441\u0430\u0445\u0430\u0440\u043d\u044b\u0439 \u0434\u0438\u0430\u0431\u0435\u0442 2-\u0433\u043e \u0442\u0438\u043f\u0430;<\/li>\n
  • \u043c\u0435\u0442\u0430\u0431\u043e\u043b\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u0441\u0438\u043d\u0434\u0440\u043e\u043c;<\/li>\n
  • \u043e\u0436\u0438\u0440\u0435\u043d\u0438\u0435;<\/li>\n
  • \u0441\u0438\u043d\u0434\u0440\u043e\u043c \u043f\u043e\u043b\u0438\u043a\u0438\u0441\u0442\u043e\u0437\u043d\u044b\u0445 \u044f\u0438\u0447\u043d\u0438\u043a\u043e\u0432;<\/li>\n
  • \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0439 \u0432\u0438\u0440\u0443\u0441\u043d\u044b\u0439 \u0433\u0435\u043f\u0430\u0442\u0438\u0442;<\/li>\n
  • \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0430\u044f \u043f\u043e\u0447\u0435\u0447\u043d\u0430\u044f \u043d\u0435\u0434\u043e\u0441\u0442\u0430\u0442\u043e\u0447\u043d\u043e\u0441\u0442\u044c;<\/li>\n
  • \u0441\u0442\u0435\u0430\u0442\u043e\u0437 \u043f\u0435\u0447\u0435\u043d\u0438;<\/li>\n
  • \u0433\u0435\u0441\u0442\u0430\u0446\u0438\u043e\u043d\u043d\u044b\u0439 \u0441\u0430\u0445\u0430\u0440\u043d\u044b\u0439 \u0434\u0438\u0430\u0431\u0435\u0442;<\/li>\n
  • \u043f\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u044f \u0433\u0438\u043f\u043e\u0444\u0438\u0437\u0430, \u043d\u0430\u0434\u043f\u043e\u0447\u0435\u0447\u043d\u0438\u043a\u043e\u0432;<\/li>\n
  • \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u043e\u043d\u043d\u044b\u0435, \u043e\u043d\u043a\u043e\u043b\u043e\u0433\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f.<\/li>\n<\/ul>\n

    \u041f\u0440\u0438\u0447\u0438\u043d\u044b \u043f\u043e\u043d\u0438\u0436\u0435\u043d\u0438\u044f<\/strong><\/p>\n

    \u041d\u043e\u0440\u043c\u0430\u043b\u044c\u043d\u044b\u0435 \u0437\u043d\u0430\u0447\u0435\u043d\u0438\u044f \u0438\u043d\u0434\u0435\u043a\u0441\u0430 IR-HOMA \u2013 \u043e\u0442\u0441\u0443\u0442\u0441\u0442\u0432\u0438\u0435 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u0440\u0435\u0437\u0438\u0441\u0442\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u0438 \u043a \u0438\u043d\u0441\u0443\u043b\u0438\u043d\u0443.<\/p>\n

    \u0427\u0442\u043e \u043c\u043e\u0436\u0435\u0442 \u0432\u043b\u0438\u044f\u0442\u044c \u043d\u0430 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442?<\/strong><\/p>\n

    \u0412\u0440\u0435\u043c\u044f \u0441\u0434\u0430\u0447\u0438 \u0431\u0438\u043e\u043c\u0430\u0442\u0435\u0440\u0438\u0430\u043b\u0430 \u043d\u0430 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435;
    \u043f\u0440\u0438\u0435\u043c \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0445 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u043e\u0432;
    \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u044c.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[912,911],"product_tag":[],"class_list":{"0":"post-11908","1":"product","2":"type-product","3":"status-publish","5":"product_cat-hormoni-de-glicoreglare","6":"product_cat-markeri-endocrini","8":"first","9":"instock","10":"sold-individually","11":"shipping-taxable","12":"purchasable","13":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/11908","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=11908"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=11908"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=11908"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=11908"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=11908"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}